Providing Comfort or Prolonging Death for a Baby with “Dead Gut Syndrome”?

1999 ◽  
Vol 8 (4) ◽  
pp. 538-538 ◽  
Author(s):  
MARK G. KUCZEWSKI
Keyword(s):  
Small Intestine ◽  
Prenatal Diagnosis ◽  
Abdominal Cavity ◽  
Length Of Gestation

The patient was born at 29 weeks gestation. There was a prenatal diagnosis that the child's small intestine had developed outside of the abdominal cavity. The length of gestation had made the initial prognosis good. But after birth, surgery to place the intestine back into the abdominal cavity found that the baby actually had very little small intestine and a diagnosis of “dead gut syndrome” was made. The amount of small intestine was not compatible with survival. The transplant service saw the baby twice and each time said the baby's profile did not meet the transplant protocol.

Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 495-498 ◽  
Author(s):  
Rajkovic ◽  
Zelic ◽  
Papes ◽  
Cizmek ◽  
Arslani
Keyword(s):  
Atrial Fibrillation ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Abdominal Cavity ◽  
Celiac Axis ◽  
Contrast Administration ◽  
Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patient’s condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

scholarly journals Application of a temporary intestinal storage device in a small intestine gunshot wound dog model

2021 ◽  
Author(s):  
Weihang Wu ◽  
Mingwei Wang ◽  
Weikang Zhou ◽  
Yuewen Zhu ◽  
Tianyu Lin ◽  
...  
Keyword(s):  
Small Intestine ◽  
Gunshot Wound ◽  
Inflammatory Cell ◽  
Treatment Time ◽  
Abdominal Cavity ◽  
First Aid ◽  
Storage Device ◽  
Wound Model ◽  
Transmission Electron ◽  
Normal Intestine

Abstract Background: We aimed to verify the feasibility of a novel temporary intestinal storage device (TISD) using a simple intestinal gunshot wound model. Methods: Ten female beagle dogs were fasted for 12 hours and anesthetized. An incision protector was inserted into a 10-cm abdominal incision. The small intestine was exposed to the body by natural drooping. An automatic rifle was used to shoot the intestine from a distance of 25 meters to introduce a simple intestinal gunshot wound. The three phases of first aid for war injuries were followed: Care Under Fire, Tactical Field Care, and Tactical Evacuation Care. For Tactical Field Care, a novel TISD was used to reconstruct the ruptured intestine, and necrotic intestinal tissue was stored. The abdominal cavity was temporarily closed, and the abdomen was opened for exploration 4 hours after surgery. Treatment time was observed during Care Under Fire, transfer time was observed from Tactical Field Care to Tactical Evacuation Care, rescue was observed during Tactical Evacuation Care, and the treatment time of each intestinal segment was measured. After 4 hours, intestinal vitality was observed, and the heart, liver, spleen, lung, kidney, stomach, normal intestine, and necrotic intestine were examined before and 4 hours after surgery by light microscopy. The broken ends of the intestine were connected to the intestinal reconstruction device before and 4 hours after surgery and were examined by transmission electron microscopy. Results: The processing time of Care Under Fire was 41.55 ± 10.46 seconds, which is shorter than the maximum time limit of the battlefield first aid principle. Transit time from Care Under Fire to Tactical Field Care transit was 60.78 ± 15.95 seconds, which is shorter than the battlefield first aid principle. The treatment time of Tactical Field Care was 29.75 ± 5.13 minutes, and the reconstruction time of each intestinal segment was 4.44 ± 0.31 minutes. One dog died of anesthetic overdose, two died of splenic bleeding, and the rest completed all phases. The abdominal cavity was explored 4 hours after surgery, and the TISD was positioned. Intestinal tract reconstruction was normal, and no obvious necrosis was observed. Necrotic intestine had the same vitality as before storage. With light microscopy, the heart, liver, spleen, lung, kidney, and stomach showed no obvious necrosis, inflammatory cell infiltration, or necrosis of normal intestine before and after surgery. Before and 4 hours after surgery, intestinal necrosis involved local necrosis of villi and tissues, and marked inflammatory cell infiltration. Transmission electron microscopy showed that the villi of the intestinal stump connected to the TISD before surgery were intact, and no obvious necrosis was observed. The villi of the intestinal stump were moderately damaged after surgery, and focal necrosis was observed. Conclusions: The novel TISD can be used in the emergency treatment of simple small intestine gunshot wounds in beagle dogs and can prevent further deterioration after intestinal injury. Background: We aimed to verify the feasibility of a novel temporary intestinal storage device (TISD) using a simple intestinal gunshot wound model.

scholarly journals The Study of the Gastrocolicomentum Influence on the Healing of the Intestinal Anastomosis in a Blood Supply Disorders of the Small Intestine

2017 ◽  
Vol 10 (4) ◽  
pp. 288-292
Author(s):  
S A Markos`yan ◽  
N M Lysyakov ◽  
M U Belyaeva
Keyword(s):  
Small Intestine ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Blood Viscosity ◽  
Intestinal Anastomosis ◽  
Abdominal Cavity ◽  
Protein Loss ◽  
Ischemic Area ◽  
Erythrocyte Sedimentation ◽  
Gastrocolic Omentum

Topicality. Currently, the problem of intestinal anastomosis reliability remains one of the most important, especially when the volume of surgical interventions is associated with significant disturbance of the blood supply to the intestine. According to the literature, the incidence of intestinal anastomosis incompetence after intestinal resection remains high and ranges from 4 to 10.2%. The aim of the study is experimental assessment of the efficiency of omentoenteropexy application for prophylaxis of intestinal anastomosis incompetence. Materials and methods. Experiments were carried out on 20 dogs divided into 2 groups. The first group consists of animals which were formed intestinal anastomosis and ligated mesenteric vessels, the second group is the animals, which in addition to the aforesaid activities were realized omentoenteropexy. Of the venous vessel, directly adjacent to the ischemic area of the small intestine, within 25 minutes after the formation of intestinal anastomosis was performed blood sampling, followed by the study of a number of indicators hemomicrocirculatory: сapillary filtrate, plasma protein loss, blood viscosity, coefficient deformation erythrocytes, erythrocyte sedimentation rate. In addition, the blood flow in the vessels of the small bowel mesentery, adjacent to the zone of ischemia, was investigated. During the postoperative period pathomorphological changes were estimated in the peritoneal cavity, mechanical strength of the junctions and stricture formation index were defined. Results. Capillary filtrate and plasma protein loss in the ischemic area of the small intestine with the anastomosis increase by 6.4 times (p <0.01) and 250% (p<0.05). Blood viscosity increased by 30.6% (p <0.01), erythrocyte sedimentation rate decreased by 30.9% (p <0.01). The number of functioning capillaries is equal to 48.5+1.8% (P <0.01). In 1 case pneumopressia test revealed intestinal anastomosis incompetence. The postsurgical period was accompanied by a significant development of adhesions in the abdominal cavity. In the study hemomicrocirculatory rates in the ischemic area of the small intestine with anastomosis, covered the greater omentum, we didn't detect reliable differences to those of the first group of animals. In all cases intestinal anastomoses were competence and adhesions in the abdominal cavity was represented by single commissures. Discussion. The paper presents the results of an experimental research on the morphological and functional changes in the ischemic area of the small intestine with the anastomosis in absense of omentoenteropexy and after covering the ischemic part organ with anastomosis by dint of the gastrocolic omentum and subsequent suturing it to the avascular part of the bowel mesentery. Performed research determined significant change of hemomicrocirculatory rates in the ischemic area of the small intestine with anastomosis in flowing venous blood from it and in the mesentery of the small intestine, directly adjacent to the avascular area. Postoperative relaparotomy showed pronounced morphological disturbances in the ischemic area of the small intestine with the anastomosis, the presence of significant adhesions in the abdominal cavity. Intestinal anastomosis incompetence was diagnosed in 1 case. Covering explored part of the small intestine by dint of the gastrocolic omentum has contributed to a more favorable regeneration flow without the development of postoperative complications in the intestinal anastomosis. There was an insignificant adhesion in the abdominal cavity in most cases. Conclusion. Thus, covering the ischemic area of the small intestine with anastomosis by dint of the gastrocolic omentum and suturing it to the avascular part of the mesentery resulted in a significant improvement in the regeneration of the intestinal anastomosis and reduction of intraperitoneal adhesions.

scholarly journals Intramural hematoma in the jejunum as a cause of colics in horses

2017 ◽  
Vol 73 (10) ◽  
pp. 671-674
Author(s):  
Bernard Turek ◽  
Roma Buczkowska ◽  
Bartłomiej Obrochta ◽  
Kamil Górski ◽  
Olga Drewnowska
Keyword(s):  
Small Intestine ◽  
Antibiotic Therapy ◽  
Fluid Therapy ◽  
Abdominal Cavity ◽  
Intramural Hematoma ◽  
Physiological Solution ◽  
Postoperative Treatment ◽  
Full Health ◽  
Life Threatening ◽  
Severity Of The Disease

Colics in horses are a common problem, which can be life-threatening for the animal, depending on the type and severity of the disease. The case described in this article concerns surgically treated intramural hematoma of the jejunum in a 3-year-old Arabian mare. Medial laparotomy was performed in dorsal recumbency under general anesthesia. During the exploration of the abdominal cavity, highly filled intestinal loops were found along with intramural hematoma located in the jejunum. A resection of the intestinal part with extravasation was performed, and the content of the small intestine was evacuated. The postoperative treatment consisted of intravenous and general antibiotic therapy as well as intensive fluid therapy for the next 5 days. The abdominal cavity was flushed two times a day with a warm physiological solution containing heparin. After 3 days the drain was removed. After the treatment the mare returned to full health.

scholarly journals MORPHOLOGICAL CHANGES IN THE SMALL INTESTINE OF RATS WITH ACUTE GENERALIZED PERITONITIS

2019 ◽  
pp. 110-113
Author(s):  
I. Ya. Dzyubanovsky ◽  
B. M. Vervega ◽  
S. R. Pіdruchna ◽  
N. A. Melnyk
Keyword(s):  
Endothelial Cells ◽  
Small Intestine ◽  
Mucous Membrane ◽  
Morphological Changes ◽  
Histological Study ◽  
Abdominal Cavity ◽  
Inflammatory Infiltration ◽  
Generalized Peritonitis ◽  
White Rats ◽  
Fecal Suspension

The main cause of mortality in acute generalized peritonitis (AGP) is the development of multiple organ insufficiency. The intestine is the organ where the first changes develop in this pathology. The aim of the study – to research and evaluate the morphological changes in the small intestine wall of animals with experimental AGP. Materials and Methods. 32 white rats were used in this study. Acute peritonitis was modeled by introduction of 10 % fecal suspension in the dosage of 0.5 ml per 100 g of the animal's weight into the abdominal cavity of rats by puncture. The terms of observation: the 1st, 3rd and the 7th days from the beginning of the peritonitis modeling. For histological study the intestinal tissue was taken. The resulting pieces of the organ were fixed in a 10 % neutral formalin solution, which were then stained with hematoxylin and eosin. Results and Discussion. On the 3rd day of the experiment in animals with a modeled AGP, vascular changes were manifested first of all by the rounding (retraction) of endothelial cells or their desquamation and the appearance of defects, that allow plasma proteins and the formed elements of blood to leave circulation boundaries of the vascular bed. On the 7 th day in animals with a modeled AGP increased vascular permeability of the mucous membrane of the small intestine was accompanied by a significant edema of the stroma of the villi and by focal hemorrhages. Conclusion. Consequently, the distinct inflammatory changes in all terms of the injury were seen in the wall of the small intestine at the simulated AGP. The significant expansion of the capillaries and venules against the background of inflammatory infiltration in the stroma of the glandular component of the small intestine was noted on the 1st day from the beginning of the experiment. An increase in the height of intestinal villus and a crypt with retraction and desquamation of endothelial cells in the wall of vessels, which caused platelet adhesion in the areas of destruction was observed on the 3rd day. The areas of focal necrosis of the superficial epithelium, which were accompanied by multiple hemorrhages per diapedesis in the perivascular space of the mucous membrane, were seen in the wall of the small intestine of animals with a simulated AGP on the 7th day.

scholarly journals Petersen's hernia after esophagectomy with antesternal jejunal reconstruction: Case report

2017 ◽  
Author(s):  
Kenji Kudo ◽  
Kosuke Narumiya ◽  
Yuji Shirai ◽  
Yosuke Yagawa ◽  
Masaho Ota ◽  
...  
Keyword(s):  
Small Intestine ◽  
Acute Abdominal Pain ◽  
Abdominal Cavity ◽  
Jejunal Loop ◽  
Emergency Laparotomy ◽  
Abdominal Ct ◽  
Right Thoracotomy ◽  
Contrast Enhanced ◽  
Petersen’S Hernia ◽  
Low Density Area

Abstract Petersen's hernia after esophagectomy is quite rare. The patient was a 75-year-old man, who had undergone esophagectomy via right thoracotomy and reconstruction with a jejunal loop by the antesternal route in 2014. In March 2015, severe acute abdominal pain occurred after endoscopy. Contrast-enhanced abdominal CT revealed a diffuse low density area in the abdominal cavity and partial dilatation of the small intestine with torsion of the superior mesenteric artery. The patient underwent emergency laparotomy, revealing chyle-like ascites and pallor of almost the entire small intestine due to circulatory impairment because of strangulation after herniation through Petersen's defect. After strangulation was relieved, the color and motility of the small intestine recovered rapidly. Then we closed the defect between the jejunal pedicle and the transverse mesocolon. This is the first English report showing Petersen's hernia after esophagectomy.

scholarly journals Mirrored Appearance of Complete Common Mesentery Discovered on CT Scan for Crohn's Disease

2021 ◽  
Author(s):  
Odette Ndikumana ◽  
Fatima Zahra Badi ◽  
Oumar Djidda ◽  
Mouna Sabiri ◽  
Samia Elmanjra ◽  
...  
Keyword(s):  
Small Intestine ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Mirror Image ◽  
Wall Thickening ◽  
Rectosigmoid Junction ◽  
History Of ◽  
The Right

Incomplete 90° intestinal rotation in a clockwise direction results in complete common mesentery being placed in a mirror image to and with a similar appearance to complete common mesentery. This rotation places the colon in the right half of the abdominal cavity and the small intestine in the left half of the abdominal cavity. We report the case of a 19-year-old patient with a history of cerebral palsy secondary to meningitis who presented with melaena and inflammatory anaemia. CT enterography was performed which showed regular, non-stenosing circumferential wall thickening of the sigmoid colon and rectosigmoid junction compatible with Crohn's disease, which was confirmed by pathophysiology. It also revealed transposition of the colon to the right hemi-abdomen and the small intestine to the left hemi-abdomen, the caecum to the right iliac fossa, and the third portion of the duodenum to the left of the mesenteric vessels.

scholarly journals Analysis of therapeutic results and complications after colic surgery in 434 horses

2008 ◽  
Vol 53 (No. 1) ◽  
pp. 12-28 ◽  
Author(s):  
J. Mezerova ◽  
Z. Zert ◽  
R. Kabes ◽  
L. Ottova
Keyword(s):  
Small Intestine ◽  
Postoperative Period ◽  
Paralytic Ileus ◽  
Abdominal Cavity ◽  
Adhesion Formation ◽  
Intestinal Resection ◽  
Colon Surgery ◽  
Common Finding ◽  
Intestinal Surgery ◽  
Small Intestinal

Out of the total number of 434 horses that underwent colic surgery, small intestine was operated in 195 (44.9%) patients, caecum in 10 (2.3%) horses, large colon surgery was performed in 196 (45.2%) cases and small colon surgery in 14 (3.2%) horses. In 12 patients (2.8%) two different parts of the gastrointestinal tract were affected simultaneously, one horse suffered from peritonitis, torsion of the uterus developed in two mares and three animals had negative surgical findings. Of 434 horses, 371 (85.5%) survived. After small intestinal surgery, 159 patients (81.5%) recovered from anaesthesia and were discharged home as well as seven horses (70%) after caecal surgery, 175 horses (89.3%) after large colon surgery and 14 horses (100%) following small colon surgery. 75 out of 103 horses (72.8%) were discharged home after the small intestinal resection and 89 of 98 horses (90.8%) with small intestinal problems where no resection was needed. In total, 43 of the patients that underwent one surgery did not survive the immediate postoperative period. The most frequent lethal complications in horses following the small intestinal surgery included peritonitis (five horses) and paralytic ileus (four horses) and in horses with large colon problems it was typhlocolitis (six cases). Relaparotomy was indicated in 41 of 434 horses (9.4%) that recovered from colic surgery. 21 out of the 41 (51.2%) relaparotomised colic patients were released from the clinic. All successfully repeated surgeries were carried out to overcome primary small intestine ileus problems, and in 14 of these cases (66.7%) resection and anastomosis were performed. The most common finding, diagnosed in 9 of 21 reoperated horses, was paralytic ileus. Of 20 relaparotomised horses that did not survive, three animals were lost after the introduction of anaesthesia, nine horses were euthanised after the abdominal cavity revision, one horse did not recover after the surgical procedure and seven horses did not survive the postoperative period. In 15 of 20 dead horses, the cause of the first surgical intervention was small intestinal ileus, in other four horses there was a large colon problem and in the last patient, it was a stomach disease. In 13 of 15 (86.7%) horses with small intestinal problems and in three of four (75%) patients with large colon disease, either resection or bypass was performed. In the remaining four non-surviving horses of 20 relaparotomised ones, peritonitis and/or adhesion formation was diagnosed at the second surgery, in three horses anastomosis complications were the main problem. Peritonitis or paralytic ileus led to death or euthanasia in four of seven horses that recovered after relaparotomy.

CHOICE OF SURGERY TACTICS IN PATIENTS WITH HIGH RISK OF ANASTOMOTIC LEAK DEVELOPMENT

2020 ◽  
pp. 25-28
Author(s):  
M. Ye. Tymchenko
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Intestinal Resection ◽  
Surgery Complications ◽  
Intestinal Anastomoses ◽  
Post Surgery ◽  
Intestinal Stoma ◽  
Small Intestinal ◽  
Surgical Tactics

Intestinal resection is one of the most common surgeries performed on urgent indications, the most difficult is the decision in favor of the formation of primary anastomosis in the case of primary infection of abdominal cavity, multiple defects of the intestinal wall, as well as the general serious condition of a patient. In order to improve the methods of diagnosis and prevention of post−surgery complications, as well as personification of surgical tactics of treatment in the patients undergoing anastomotic surgeries in intestine, the results of treatment of 96 patients were analyzed. The level of serum cryoglobulins was determined by the method of A. E. Kalovidoris with modifications. The results of surgical treatment were evaluated according to the classification of D. Dindo et al. (2004). The use of cryoglobulin levels before surgery can significantly affect surgical tactics: at a low degree it is possible to perform resection of a segment of small intestine with the formation of primary small intestinal anastomoses; at average − it is possible to perform small−intestinal anastomoses with unloading intestinal stoma or with the location of the anastomosis extraperitoneally (if possible) and decompression of the anastomosis with an incubation probe; at high − it is expedient to supplement performance of an anastomosis with a variant of an enterostomy or "delayed" anastomoses, at a severe general condition of patients it is expedient to form final small intestinal stoma. Determining the level of cryoglobulinemia as a marker of the prognosis of failure of the sutures of intestinal anastomoses and the use of differentiated surgical tactics depending on the level of this index contributes to a significant improvement in direct results of surgical treatment of the patients undergoing resection of small intestine segments. The proposed tactics virtually eliminate the implementation of multi−stage surgical interventions and helps to reduce the duration of treatment of patients, reduce the level of post−surgery complications and mortality. Key words: cryoglobulinemia, surgical treatment, small intestine, anastomoses.

Clinico-pathologic pattern of gastrointestinal stromal tumors (GIST) in southern India: A single-institution experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20531-20531
Author(s):  
M. Lamba ◽  
G. Mukherjee ◽  
K. Saini ◽  
C. Ramachandra ◽  
C. Rao ◽  
...  
Keyword(s):  
Small Intestine ◽  
Stable Disease ◽  
Tumor Size ◽  
Abdominal Cavity ◽  
Mitotic Rate ◽  
Behavioral Pattern ◽  
Response To Treatment ◽  
Pharmacological Intervention ◽  
Mixed Cell ◽  
Pathologic Features

20531 Background: There have been major advances in understanding the behavioral pattern, pharmacological intervention, and clinical response of GIST; yet Indian data in this regard is sparse. This study analyses the clinico-pathologic features in 36 patients (21 male, 15 female) of GIST seen at our institution. Methods: GIST was defined as a mesenchymal spindle or epithelioid cell lesion arising in the GI tract with CD117 immuno-reactivity. Retrospective data from January 03 to March 06 was analyzed for age, tumor site, morphology, immuno- reactivity, prognostic factors, response to treatment (by RECIST), and recurrence or metastasis. All patients had surgery; those with residual, recurrent, or metastatic disease got imatinib till tumor progression. Results: GIST presented at a mean age of 48.2 yrs (SD 6.4, range 34–65). The mean tumor size was 13.9 cm (range 2–42). The most common site was the small intestine (ileum 8, jejunum 7, duodenum 4). 24 patients (66.7%) had localized disease at baseline. Of these, 14 had local recurrence after surgery, and were given imatinib. 5 of them are in complete remission, 4 had partial response (PR), 3 patients died, and 2 had stable disease. Most patients with recurrent GIST had a mitotic rate of >10/50hpf. 8 patients developed metastasis, and received imatinib. Of these, 2 got a PR, 3 had progressive disease and died, and 3 had stable disease. 12 patients (33.3%) had metastasis at baseline (to liver and abdominal cavity), and underwent debulking. Of these, 6 patients with stable disease are on treatment with imatinib, 3 died and 3 were lost to follow-up. Conclusions: Average age of presentation was less than in Western reports. The commonest site was the small intestine as opposed to stomach in western literature. Mitotic rate was a better prognostic factor than gross tumor size. GIST with a mixed cell morphology showed aggressive behavior. Imatinib mesylate is useful in the post-operative management of GIST. [Table: see text] No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document